By Alisson Richards, MD, Wellpath – Vermont Department of Corrections. and Elizabeth Samson, MA, LMHC, CCHP, Wellpath.
The Health Services division of the Vermont Department of Corrections (VTDOC), in partnership with Wellpath, launched a statewide quality improvement initiative to standardize prescribing practices for stimulant medications used in the treatment of attention-deficit/hyperactivity disorder (ADHD).
The effort was driven by concern about increasing stimulant use, both within Vermont and nationally, as well as the potential risks associated with misuse, diversion, and adverse outcomes.
Within correctional settings, these challenges are often compounded by variability in documentation at intake, differences in provider practice patterns, and the absence of standardized expectations across sites.
Recognizing these risks, VTDOC took a proactive approach—focusing on consistency, safety, and clinical appropriateness.
Identifying the Opportunity
A review of prescribing patterns across facilities revealed variation in how stimulant medications were initiated, documented, and continued. In many cases, providers were making thoughtful clinical decisions, but without a shared framework, practices differed from site to site.
This variability created an opportunity to strengthen alignment around several things:
- Diagnostic expectations
- Documentation standards
- Prescribing practices
- Ongoing monitoring
The goal was not to limit access to care, but to ensure that prescribing decisions were consistent, evidence-informed, and well-documented across the system.
Building a Standardized Approach
The initiative was led by the statewide psychiatric director in close collaboration with quality, medical, and operational leadership. Together, the team developed clear, standardized expectations for stimulant prescribing.
Key components included:
- Defined diagnostic criteria to support appropriate initiation and continuation of medications
- Standardized documentation expectations
- Provider education and training
- Data monitoring and reporting
A pharmacy partner supported data collection and analysis, allowing the team to evaluate prescribing patterns across the system and identify areas for improvement. Throughout implementation, the message remained consistent: this was a quality and patient safety initiative—not a restriction effort. Patients meeting appropriate clinical criteria continued to receive needed treatment.
Implementation and Results
Education and communication were central to success. Psychiatry and mental health staff received targeted training, and leadership reinforced expectations through ongoing engagement and support.
Prescribing trends were monitored using a standardized rate to allow for meaningful comparison over time. Within one year of implementation, the system saw a 56% reduction in stimulant prescribing rates.
Importantly, this change reflected improved alignment with diagnostic and prescribing standards—not decreased access to care. Patients with clear clinical indications continued to receive appropriate treatment, while unnecessary or inconsistent prescribing decreased.
Sustaining the Improvement
To ensure long-term success, the initiative was embedded into existing Continuous Quality Improvement (CQI) processes. Ongoing strategies include:
- Routine monitoring of prescribing trends
- Periodic review of high-risk or outlier cases
- Continued provider education
- Oversight at both the site and system levels
By integrating these practices into CQI, VTDOC created a sustainable framework that supports continuous evaluation and adaptation as new risks or trends emerge.
Lessons Learned
Standardization reduces variability. Clear expectations help align providers while still allowing for clinical judgment.
Education is critical. Providers are more likely to adopt changes when they understand the “why” behind them.
Data drives improvement. Ongoing monitoring allows organizations to identify trends, measure impact, and respond proactively.
Framing matters. Positioning the initiative as a patient safety and quality effort—not a restriction—was essential to gaining buy-in.
Implications for Other Systems
Correctional systems across the country face similar challenges related to prescribing variability and evolving public health risks. This initiative demonstrates that a structured, collaborative approach can:
- Improve consistency in clinical practice
- Enhance patient safety
- Support providers with clear expectations
- Create sustainable, systemwide change
Organizations looking to implement similar efforts can start by assessing current prescribing patterns, engaging clinical leadership, and building standardized expectations supported by education and data.
Conclusion
The VTDOC statewide collaborative initiative highlights the power of aligning clinical leadership, quality improvement, and data-driven decision-making to address complex health care challenges.
By focusing on consistency, education, and continuous monitoring, the system strengthened prescribing practices while maintaining access to appropriate care.
Alisson Richards, MD, is statewide psychiatric director of Wellpath – Vermont Department of Corrections. Elizabeth Samson, MA, LMHC, CCHP, is vice president of quality at Wellpath.
This article was featured in the Fall 2026 issue of CorrectCare.
